Provider Demographics
NPI:1972211969
Name:JOHNSON, MARGARET BROTHERS (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:BROTHERS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 JUNIATA ST FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3930
Mailing Address - Country:US
Mailing Address - Phone:573-673-3799
Mailing Address - Fax:
Practice Address - Street 1:2901 HIGH RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2212
Practice Address - Country:US
Practice Address - Phone:636-677-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist